Anorexia and bulimia nervosa in the practice of the paediatric dentist.

OBJECTIVE: This systematic review aimed to highlight the usefulness of the clinical examination of the oral cavity for the diagnostic suspicion of anorexia (AN) and bulimia nervosa (BN), being of main interest to the paediatric dentist and paediatrician due to the early onset of symptoms in Eating Disorders (EDs). METHOD: A systematic search, applying PICO question, was carried out in biomedical and other electronic databases from 2005 to 2020. Both case reports and case series of patients under 65 years of age with AN and BN were included. Data were extracted and statistically analysed. RESULTS: A sample of 111 studies was obtained (n = 192; 92.78% female). The most prevalent diagnosis was restrictive type AN (n = 110; 57.29%). Only 16 (8.33%) patients had been clinically examined at the oral cavity, indicating the presence or absence of oral manifestations (OM) and showing dental erosion (n = 10) as the most frequent. CONCLUSION: There is a lack of information about the oral examination of anorexic and bulimic patients. Dental erosion and other oral manifestations can help us to make an early ED diagnosis. Clinical observation and basic erosive wear examination (BEWE) Index are necessary steps to detect and record any anomaly in oral cavity during the evaluation of these patients.

Acidic food choice among adolescents with bulimic symptomatology: a major risk factor for erosive tooth wear?

PURPOSE: Evaluate dietary habits and the presence of erosive tooth wear (ETW) among female adolescents with varying severity of bulimic symptomatology. METHODS: An explanatory study was conducted with 72 female school adolescents with bulimic symptomatology, aged 15-18 years in Southeastern Brazil. Dietary habits were evaluated through a food frequency questionnaire. Bulimic symptomatology was evaluated and classified (mild, moderate and severe) according to the Bulimic Investigatory Test of Edinburgh. ETW examinations were performed. Data analysis involved descriptive statistics, bivariate analysis, Kruskal-Wallis/Mann-Whitney tests and Poisson regression. Ethical approval and informed consents were obtained. RESULTS: The final population consisted of 62 participants. The prevalence of ETW differed among adolescents with mild, moderate and severe bulimic symptomatology (p = 0.001), corresponding to 5.9%, 8.0% and 45.0%, respectively. Adolescents with severe bulimic symptomatology presented higher daily consumption of acidic food: citric fruits (p < 0.005), diet soda (p < 0.009) and ketchup (p = 0.004). No difference related to vomiting practices was observed between groups (p = 0.060). The adjusted regression model showed that a higher prevalence of ETW was associated with self-induced vomit at least once a week (PR = 2.42, 95% CI = 1.00-5.86, p = 0.05) and higher frequencies of consumption of citric fruits (PR = 7.96, 95% CI = 1.50-42.11, p = 0.015) and diet soda (PR = 2.32, 95% CI = 1.09-4.91, p = 0.029). CONCLUSION: It was the food choices (acidic food) and not purging practices that differed among adolescents with varying severity of bulimic symptomology. Likewise, higher consumption of citric fruits was the main factor associated with higher prevalence of ETW. LEVEL OF EVIDENCE: III case-control analytic study.

Eating disorders and the orthodontist: Diagnosis, considerations and referral.

BACKGROUND: Eating disorders are relatively common mental health disorders in Western European and North American populations. The peak incidence occurs within the adolescent years, which correlates with the largest orthodontic patient population. The morbidity associated with these psychological conditions is significant, and has a direct impact upon patient well-being, orthodontic outcomes and the success of treatment. Therefore, it is of relevance to the orthodontist to be aware of potential presenting features of these conditions, when and where to seek advice, and how such disorders may impact upon orthodontic outcomes. METHODS: Articles published on PUBMED and MEDLINE relevant to orthodontics and eating disorders were reviewed. Key information was extracted, and the relevant evidence for the orthodontist summarised. RESULTS: Eating disorders may present to the orthodontist in specialist or hospital practice, either undiagnosed or as a co-morbidity. Orthodontists may benefit from an appreciation of these potential diagnoses, the orthodontic implications and to have the confidence to refer their patients to the necessary services. LIMITATIONS: There is little existing research in this area. CONCLUSIONS: These conditions have a significant impact on patient morbidity and mortality. This cohort of patients is not suitable for orthodontic treatment while their disease is active. The impact of a developing eating disorder can adversely affect orthodontic treatment.

Prevention of Enamel Softening by Rinsing with a Calcium Solution before Dental Erosion.

OBJECTIVES: This in situ study aimed to evaluate whether rinsing with a calcium-containing solution prior to an erosive attack reduces the softening of enamel. MATERIALS AND METHODS: A total of 240 bovine enamel samples with determined baseline surface microhardness (KHN) were allocated to 5 runs in which each of the 12 volunteers performed the following experiment: 4 enamel samples were inserted in a custom-made intraoral appliance and carried in the mouth (upper jaw) for 30 min before each volunteer either rinsed his mouth for 60 s with a fluoride- and stannous ion-containing dental erosion protection mouth rinse as positive control (run 1), milk (run 2), a solution prepared from a 500-mg calcium effervescent tablet dissolved in 100 mL (run 3) or 200 mL (run 4) water, or did not perform any rinsing with a test solution before the erosive attack (run 5, negative control). To simulate the erosive attack, volunteers rinsed their mouth with a commercial soft drink (Sprite Zero) for 60 s and afterwards with water to stop the erosive process. Finally, surface microhardness was measured again and hardness loss (ΔKHN) calculated. A mixed effect model was fitted to the data set to investigate whether the different runs showed differences with respect to ΔKHN. RESULTS: No significant difference in softening of enamel (mean of ΔKHN; lower confidence level/upper confidence level) was observed between the negative control run 5 (50.7; 60.8/40.6), run 2 (50.7; 60.8/40.6), run 3 (38.7; 48.8/28.6) and run 4 (40.7; 50.8/30.6) (p > 0.05, respectively). Enamel softening in the positive control run 1 (25.4; 35.6/15.3) was significantly lower compared to the softening in run 5 (p < 0.001). No significant difference was observed between run 1 and run 3 (p = 0.09). CONCLUSION: Other than the fluoride- and stannous ion-containing dental erosion protection mouth rinse, none of the investigated calcium-containing solutions is able to significantly reduce erosion-induced softening of enamel.

Necrotizing Sialometaplasia and Bulimia: A Case Report.

Bulimia is an eating disorder with a great prevalence in young women. Due to its multifactor ethiology, bulimia has systemic consequences. In the literature, necrotising sialometaplasia is seldom associated with bulimia. Its etiopathogenesis is discussed by several authors; nevertheless, the consensus does not consider the relevance of local trauma associated with induced vomiting. A case of necrotising sialomethaplasia, presented with a single hard palatal ulcer in a bulimic woman is described in the present report. The patient did not present significant systemic laboratorial values, nor physical weight variations, which highlights the relevance of performing a complete medical clinical history when diagnosing this rare pathology.

Impaired cortisol awakening response in eating disorder women with childhood trauma exposure: evidence for a dose-dependent effect of the traumatic load.

BACKGROUND: Childhood trauma is a non specific risk factor for adult eating disorders (ED), and the hypothalamic-pituitary-adrenal (HPA) axis seems to mediate such a risk. Here we explored the impact of different types of childhood trauma and of traumatic load on the cortisol awakening response (CAR) of women with anorexia nervosa (AN) or bulimia nervosa (BN). METHODS: Saliva samples were collected at awakening and after 15, 30, 60 min to measure cortisol levels by 121 women (44 AN patients, 36 BN patients and 41 healthy women). Participants filled in the Childhood Trauma Questionnaire. RESULTS: AN and BN patients with childhood maltreatment exhibited an attenuated CAR compared with non-maltreated ones. In the whole ED patient group, the CAR showed a progressive impairment with the increasing number of reported trauma types. Although significant negative correlations emerged between the type or the number of traumas and the CAR, only the number of traumas remained significantly associated with the CAR in a stepwise multiple regression analysis. CONCLUSIONS: Present findings confirm that childhood trauma is associated with an impaired CAR in adult AN and BN patients and demonstrate for the first time a negative dose-dependent effect of the traumatic load on HPA axis activity.

Orofacial manifestations in outpatients with anorexia nervosa and bulimia nervosa focusing on the vomiting behavior.

OBJECTIVE: This case-control study aims to evaluate the oral health status and orofacial problems in a group of outpatients with eating disorders (ED)-either anorexia nervosa (AN) or bulimia nervosa (BN)-further focusing on the influence of vomit. MATERIALS AND METHODS: Fifty-five women outpatients with AN or BN diagnosis were invited to participate, of which 33 agreed. ED outpatients and matched controls were submitted to a questionnaire and clinical oral examination. RESULTS: Multivariate analysis identified a significantly higher incidence of teeth-related complications (i.e., tooth decay, dental erosion, and self-reported dentin hypersensitivity), periodontal disease, salivary alterations (i.e., hyposalivation and xerostomia), and oral mucosa-related complications in ED outpatients. Dental erosion, self-reported dentin hypersensitivity, hyposalivation, xerostomia, and angular cheilitis were found to be highly correlated with the vomiting behavior. CONCLUSIONS: ED outpatients were found to present a higher incidence of oral-related complications and an inferior oral health status, compared to gender- and age-matched controls. Alterations verified within outpatients were acknowledged to be quite similar to those previously reported within inpatients, in both of nature and severity, thus sustaining that the cranio-maxillofacial region is significantly affected by ED, even in the early/milder forms of the condition, as expectedly verified within outpatients.

Oral health considerations in anorexia and bulimia nervosa. 1. Symptomatology and diagnosis.

Eating disorders have captured the attention of medical and dental professionals as well as the public for decades and continue to raise concern today. The literature devoted to anorexia and bulimia highlights myriad psychological, systemic, and dental health complications. Dental practitioners are in a unique position to discover early manifestations of these disorders. The present article reviews anorexia and bulimia, summarizing telltale behavioral traits, systemic manifestations, and dental features to facilitate recognition and enable accurate diagnosis.

Oral health considerations in anorexia and bulimia nervosa. 2. Multidisciplinary management and personalized dental care.

This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.

The effects of ovarian hormones and emotional eating on changes in weight preoccupation across the menstrual cycle.

OBJECTIVE: Previous research has shown that fluctuations in ovarian hormones (i.e., estradiol and progesterone) predict the changes in binge eating and emotional eating across the menstrual cycle. However, the extent to which other eating disorder symptoms fluctuate across the menstrual cycle and are influenced by ovarian hormones remains largely unknown. This study sought to examine whether the levels of weight preoccupation vary across the menstrual cycle and whether the changes in ovarian hormones and/or other factors (i.e., emotional eating and negative affect) account for menstrual cycle fluctuations in this eating disorder phenotype. METHOD: For 45 consecutive days, 352 women (age, 15-25 years) provided daily ratings of weight preoccupation, negative affect, and emotional eating. Saliva samples were also collected on a daily basis and assayed for levels of estradiol and progesterone using enzyme immunoassay techniques. RESULTS: Weight preoccupation varied significantly across the menstrual cycle, with the highest levels in the premenstrual and menstrual phases. However, ovarian hormones did not account for within-person changes in weight preoccupation across the menstrual cycle. Instead, the most significant predictor of menstrual cycle changes in weight preoccupation was the change in emotional eating. DISCUSSION: Fluctuations in weight preoccupation across the menstrual cycle appear to be influenced primarily by emotional eating rather than ovarian hormones. Future research should continue to examine the relationships among ovarian hormones, weight preoccupation, emotional eating, and other core eating disorder symptoms (e.g., body dissatisfaction, compensatory behaviors) in an effort to more fully understand the role of these biological and behavioral factors for the full spectrum of eating pathology.

Should we screen for misophonia in patients with eating disorders? A report of three cases.

In this case report, the authors describe three cases of misophonia in people with eating disorders. Misophonia is a condition where a specific trigger sound provokes an intense emotional reaction in an individual. Case 1 is a 29-year-old with childhood eating issues, anorexia nervosa and bulimia nervosa whose trigger was a high-pitched female voice. Case 2 is a 15-year-old diagnosed with anorexia nervosa after misophonia onset. Her trigger was people chewing and eating noisily. Case 3 is a 24-year-old woman who presented with anorexia nervosa prior to misophonia onset. Her trigger was the clinking and chewing of her mother and aunt eating cereal. All three cases identified an eating-related trigger sound with a violent aversive reaction and coping mechanisms involving eating avoidance or having a full mouth. Misophonia may be associated with presentations of eating disorders. This case report adds to the literature about the presentation of misophonia.

[Triggers of bulimia and compulsion attacks: validation of the "Start" questionnaire]. / Les inducteurs des crises dans la boulimie et la compulsion : validation du questionnaire « Start ¼

AIM: There are few published studies on the triggers of binge eating in anorexia nervosa of binge/purging subtype (BPAN), bulimia nervosa (BN) and binge eating disorder (BED). PATIENTS AND METHODS: We validated in 29 patients (10 BPAN, 10 BN and 9 BED) the perspicuity, the clarity and the intra- (doubles) and inter- (test-retest) reproducibility of a 24-item Start questionnaire on the triggers of binge eating. Then the Start questionnaire was administered to 176 patients (65 BPAN, 62 BN and 59 BED patients) being 27.5+9.1 yr old, having 15+9 binge eating (BE) episodes/week, with a mean binge duration of 1 hr 36min (+ 38min)/day. RESULTS: BE episodes occurred mainly during the second part of the day: afternoon after work (67% of the patients), "tea" time (55%), evening after dinner (42%) and at night (22%). The principal place for BE episodes was at home (96%). The BED patients avoided binges at the parents' home (89%) more often than the BPAN (62%, P<0.02). The binges occurred mainly in the living room (44%), in the kitchen (43%), and less in the bedroom (31%). Hunger pangs seemed to be a trigger of binges in 31% of the patients, and a stronger trigger in BED (42%) than in the BPAN and BN patients (24%; P=0.04). Binge eating episodes could occur despite a high satiety level (just after lunch or dinner) in 29% of the BN and in 16% of the BED patients (P<0.02). Concerning food, the major triggers were high energy-density food (77%) and comfort food (60%), such as chocolate, cakes, bread and pasta. The food consumed for binge episodes (in-binge food) was more often a strong trigger than the other food (not used for binges): olfaction (19% versus 10%), sight (52% versus 25%) and placing in the mouth (71% versus 26%; P<0.02 for all, in the 3 groups). Being tired could be a strong trigger in 37% of the patients, but "being aroused" in the other 38 % of the patients. Stressful events (65%), anxiety (74%), "being under pressure" or irritated (51% and 55%) were of course major triggers in a majority of the patients, as well as sadness (61%), feeling of powerlessness (62%), inefficiency (73%) and depressive state (71%). Flashback from traumatism (sexual trauma in 17% of the patients) was a strong trigger of binges more often in BPAN and BED (44%) than in BN (23%; P<0.05). The binge eating was painful (and "not at all a pleasure") in 69% of the patients, but could also be a relaxing behavior in 31% of the patients, more often in the BED (43%) than in the BPAN patients (20%; P<0.05). The binge eating behavior was quoted as obsessive in 63% of BPAN, 92% of BN and only 34% of BED patients (P<0.001). The patients said that they were unable to avoid the binge (76% of the patients), more often in BPAN and BN than in BED patients (P<0.01). As a whole, 62% of BPAN, 89% of BN and only 4 % of BED patients (P<0.05) were unable to avoid purging (vomiting). In 12% of the cases, there was a pleasure felt when binging. For the other patients, shame, filth and incapacity were the feelings related to binges in 58% of the BPAN, 45% of BN and 43% of BED patients (P<0.04). The global score of addiction (zero=not addicted, 10=very addicted) was 8.56+1.2 in BPAN, 8.42+1.5 in BN and 6.74+1.1 in BED patients (NS between BPAN and BN; P<0.01 between BPAN and BN on the one hand and BED on the other). CONCLUSION: The present study has demonstrated the usefulness of the Start questionnaire. It also evidences the key role of intrinsic factors, both metabolic and emotional, as strong triggers for binge eating episodes in BPAN, BN and BED. It has also demonstrated the role of environmental determinants.

Oro-dental manifestations of eating disorders: a systematic review.

BACKGROUND: Eating disorders (EDs) pose a significant risk to health, especially when not diagnosed early. For several years EDs and oral health has been extensively studied, and now it is quite clear the existence of a correlation between specific oral manifestations and these disorders. While these oral signs could potentially aid early diagnosis of EDs, their identification and the eventual establishment of a correlation is currently heavily limited to the clinician's experience. The present systematic review critically examines existing literature, offering an updated overview of oro-dental manifestations associated with EDs. METHOD: MEDLINE (via PubMed), Web of Science, Scopus, and grey literature were searched, and relevant epidemiological comparative studies were screened using the Rayyan software. No limitations have been imposed on the research regarding oro-dental outcomes, encompassing all medically diagnosed EDs. The quality of the studies was valuated using AXIS appraisal tool for cross-sectional studies. RESULT: Out of 3990 studies, 32 fulfilled the eligibility criteria and were included in the synthesis. The identified eating disorders include Anorexia Nervosa, Bulimia Nervosa and/or Eating Disorders Not Otherwise Specified, predominantly among female subjects, primarily originating from Europe. The evaluated oro-dental outcomes include dental erosion, caries, saliva assessment, hygiene-periodontal parameters, and mucosal tissue appearance. The association with erosion is confirmed while gingival recession, dentinal hypersensitivity, salivary flow thresholds and aspects relating to oral pathology are receiving increasing support from emerging evidence. DISCUSSION: This trend emphasizes the critical role of the complete intraoral examination to detect significant oro-dental signs that may indicate the onset of an ED.

The article is a review of existing studies that explores the link between eating disorders and oral health issues. It found that people with eating disorders, including anorexia nervosa and bulimia nervosa, may experience dental problems such as tooth erosion, cavities, and altered saliva production. The review findings emphasize the importance of dental care providers recognizing these signs early and suggests better training for dental professionals. By doing so, they can help diagnose eating disorders sooner and recommend appropriate treatment. This approach aims to improve patients' overall wellbeing by addressing both the oral health issues and the underlying eating disorders, making it essential for patients and medical teams to be aware of the interconnectedness between oral health and eating disorders.

Eating disorder risk behavior and dental implications among adolescents.

OBJECTIVE: To compare the occurrence of tooth erosion (TE) and dental caries (DC) in adolescents with and without risk behavior for eating disorders (EDs). METHOD: A controlled cross-sectional study involving 1,203 randomly selected female students aged 15-18 years was conducted in Brazil. Risk behavior for EDs was evaluated through the Bulimic Investigatory Test of Edinburgh and dental examinations were performed. RESULTS: The prevalence of risk behavior for EDs was 6%. Twenty adolescents (1.7%) were identified with severe risk behavior for EDs and matched to 80 adolescents without such risk. Among the severe risk group, 45% of adolescents were affected by TE and 80% by DC compared with 8.8 and 51.3%, respectively, in the matched group. Adolescents with severe risk had higher chances for TE (OR = 10.04; 95% CI = 2.5-39.4). DISCUSSION: In this study, a severe risk behavior for EDs was significantly associated with TE, but not with DC.

Frequency of symptoms and the associated factors of eating disorders in a group of dental students in Medellín, Colombia.

BACKGROUND: Eating disorders (EDs) are considered a public health problem. Scientific research has focused on teenagers due to their higher prevalence in this population. However, other groups, such as university students, may be exposed to suffering from EDs due to their academic, social and personal characteristics. Identifying the magnitude of EDs and the associated characteristics may impact the generation of prevention strategies. OBJECTIVES: The aim of the present study was to establish the prevalence of the risk of EDs (anorexia nervosa (AN) and bulimia nervosa (BN)) and the associated factors in dental students at the University of Antioquia, Medellín, Colombia.. MATERIAL AND METHODS: A cross-sectional study was conducted on 278 students (76 males, 202 females) with the use of a Google-Forms survey. The validated Spanish version of the Eating Attitudes Test-26 (EAT-26) and the Sick, Control, One Stone, Fat, Food (SCOFF) questionnaire were used. Other recorded variables included sociodemographic data, coronavirus disease 2019 (COVID-19)-related factors, health, and social support (the Duke-11 profile). The bivariate analysis of the risk of EDs was conducted according to different variables (95% confidence interval (CI)), followed by the logistic regression models adjusting for different variables (adjusted prevalence ratio (aPR) and 95% CI). RESULTS: According to EAT-26, the risk of EDs was 27.6% (18.8-38.6) for males and 28.7% (22.9-35.3) for females. However, differences between males and females were higher when the SCOFF questionnaire was applied (males: 6.6% (2.8-14.5); females: 22.3% (17.1-28.5); p < 0.01). According to the SCOFF instrument, after adjusting for sociodemographic and health variables, women were more likely to report the symptoms of EDs (aPR: 2.20; 95% CI: 1.06-4.57). Women receiving information from social networks were more likely to report the symptoms of EDs (aPR: 1.85; 95% CI: 1.19-2.88). Multivariate models showed that women reporting poor self-rated health and some symptoms during the mandatory confinement caused by the COVID-19 pandemic were more likely to report the symptoms of EDs. CONCLUSIONS: A higher risk of EDs was found in dental students. Healthcare, psychological and/or psychiatric interviews, and educational/early prevention strategies are required.

Eating Disorders and Dental Erosion: A Systematic Review.

Both eating disorders and dental erosion are increasingly affecting adolescents and young adults. Thus, our systematic review was designed to answer the question: "Is there a relationship between dental erosion and eating disorders?" Following the inclusion and exclusion criteria, 31 studies were included in this systematic review (according to the PRISMA statement guidelines). Based on the meta-analysis, 54.4% of patients with bulimia nervosa and 26.7% with anorexia nervosa experienced tooth erosion. For the whole group of 1699 patients with eating disorders, erosive lesions were observed in 42.1% of patients. Bulimics were more than 10 times more likely to experience dental erosion compared to healthy individuals (OR = 10.383 [95%CI: 4.882-22.086]). Similarly, more than 16 times increased odds of tooth erosion were found in patients with self-induced vomiting (OR = 16.176 [95%CI: 1.438-181.918]). In conclusion, eating disorders are associated with an increased risk of developing erosive lesions, especially in patients with bulimia nervosa.

Barrett's esophagus in a patient with bulimia nervosa: A case report.

BACKGROUND: Barrett's esophagus is a known complication of long-standing gastroesophageal reflux disease, and it is a potential risk factor of developing esophageal adenocarcinoma. CASE SUMMARY: Here, we present a case of a 47-year-old male patient referred to the gastroenterology clinic for upper endoscopy because he has a long-standing history of heartburn and vomiting after meals. On examination, he had characteristic findings of self-induced vomiting as abrasions and callosities on the dorsum of the right hand and dental erosions. A detailed history revealed that he had 17 years of binge eating with self-induced vomiting. His upper endoscopy showed gastroesophageal reflux grade D with salmon-red mucosal projections, and the biopsy revealed intestinal mucosal metaplasia. CONCLUSION: This case emphasized the importance of considering upper endoscopy screening for Barrett's esophagus in patients with eating disorders, especially those with self-induced vomiting, as in bulimia nervosa.

Bupropion-induced acute dystonia in a patient with bulimia nervosa: A case report.

Bupropion is taken as an antidepressant for treatment of major depressive disorders, treatment of sexual side effects of selective serotonin reuptake inhibitors, and as a smoking cessation aid, however, it may result in adverse effects such as nausea, dry mouth, headache, insomnia, dizziness, anxiety, tremor, and constipation. We investigate the case of a 34-year-old woman with bulimia nervosa where acute dystonia was induced by bupropion in 8 months. Following this diagnosis and after normal tests and MRI results, the patient was advised to discontinue bupropion intake. In the follow-up done 2 weeks later, 3 months later, and 6 months later, no signs of acute dystonia was observed. A physician who administers dopamine blocking agents must be aware of the prevalence of and the risk factors for acute dystonia and also the way of prevention and treatment.

Common and Emergent Oral and Gastrointestinal Manifestations of Eating Disorders.

Eating disorders (EDs) such as anorexia nervosa, bulimia nervosa, and avoidant/restrictive food intake disorder are associated with restricted diets and abnormal compensatory behaviors, frequently leading to malnutrition and oral and gastrointestinal manifestations. Dental and oral complications are generally caused by malnutrition, micro-nutrient deficiency, and chronic acid exposure; hence, treatment of the ED and frequent dental examinations are essential to reduce morbidity. Gastrointestinal manifestations are multifactorial in origin, and may be caused by disordered behaviors, malnutrition, anxiety, and/or may be a function of the ED itself. This article reviews the most common oral and gastrointestinal manifestations of EDs and describes emergent complications such as acute gastric dilation and superior mesenteric artery syndrome. It is important for providers to recognize complications associated with EDs to provide the best treatment possible.

Early traumatic experiences impair the functioning of both components of the endogenous stress response system in adult people with eating disorders.

Childhood trauma is a non-specific risk factor for eating disorders (EDs). It has been suggested that this risk is exerted through trauma-induced long-lasting changes in the body stress response system. Therefore, we explored the activity of the hypothalamus-pituitary-adrenal axis and of the sympathetic nervous system in adult ED patients with or without a history of childhood trauma exposure. Salivary cortisol and alpha-amylase, a marker of the sympathetic nervous system activity, were measured at awakening and after 15, 30 and 60 min in 35 women with EDs. The Childhood Trauma Questionnaire (CTQ) was employed to assess exposure to childhood trauma and, according to the CTQ cut-off scores, 21 ED women were classified as maltreated (Mal) participants and 14 women as no-maltreated (noMal) ED participants. Compared to noMal ED women, Mal ED participants showed significantly decreased cortisol awakening response (between group difference: p = 0.0003) and morning salivary alpha-amylase secretion (between group difference: p = 0.02). Present results confirm that the cortisol awakening response of adult ED patients with childhood trauma exposure is lower than that of adult ED patients without childhood trauma experiences and show for the first time that also the morning secretion of salivary alpha-amylase is decreased in adult ED patients who have been exposed to early traumatic experiences. These results point for the first time to a dampening in the basal activity of both components of the endogenous stress response system in childhood maltreated adult ED women.